Provider Demographics
NPI:1457496200
Name:DAVALOS, SHARON ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3498 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55319-9235
Mailing Address - Country:US
Mailing Address - Phone:320-743-3873
Mailing Address - Fax:763-689-7716
Practice Address - Street 1:701 DELLWOOD ST S
Practice Address - Street 2:CAMBRIDGE MEDICAL CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1920
Practice Address - Country:US
Practice Address - Phone:763-689-7782
Practice Address - Fax:763-689-7716
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist